A-1 Information Systems

Phone: 838-9009 Fax: 838-1115

Internet: http://www.a1.com
Intranet: http://www.a1.is.com/is

DATE OF REQUEST SERVICE REQUESTED FOR ORGANIZATION

<date>

SUBMITTED BY (key user contact) EXECUTIVE SPONSOR (funding authority)

Name Name Peter Charles
Title Title President
Office Office
Phone Phone ext. 5

TYPE OF SERVICE REQUESTED:

Information Strategy Planning Existing Application Enhancement
Business Process Analysis and Redesign Existing Application Maintenance (problem fix)
New Application Development Not Sure
Other (please specify
________________________________________________________

BRIEF STATEMENT OF PROBLEM, OPPORTUNITY, OR DIRECTIVE (attach additional

documentation as necessary)

BRIEF STATEMENT OF EXPECTED SOLUTION

ACTION (IT Office Use Only)

Feasibility assessment approved
Feasibility assessment waived
Request delayed
Request rejected
Authorized Signatures:
______________________________
Assigned to ______________________
Approved Budget $ ___________________
Start Date ________ Deadline _____________
Backlogged until date: ______________
Reason: ______________________________
__________Jack Mills_________________
Project Executive Sponsor